Subarachnoid haemorrhage 1B Flashcards
What is the typical presentation in SAH and what is the timeline
a thunderclap headache that peaks within 1-5 minutes and last >1hr
What other typical symptoms are seen
sentinel headache which is milder days to weeks preceeding, vomiting, seizures, collapse and loss of consciousness
The most pathological cause of SAH is ?
a rupture of a berry (aka saccular) aneurysm in the circle of Willis
Peak onset of SAH is between what age range?
Peak onset is 40-60 years old.
One classical sign which can be seen in SAH after 6hrs is
kernig’s sign and other signs of meningism e.g. stiff neck
A risk factor that causes arteriovenous malformation is
autosomal dominant polycystic kidney disease
Between lupus, Ehlers Danlos and Marfan’s. which ones are risk factors for SAH
Ehlers Danlos and Marfan’s.
A clotting profile investigation may show what which points towards SAH
coagulopathy
U&E may show derangement of which electrolyte and why
hyponatraemia due to cerebral salt wasting
SAH can cause cardiac abnormalities
long QT
When is Non-contrast CT most sensitive for in the diagnosis of SAH
first 6 hours
When can a lumber puncture be done
after 12 hours if CT is negative
Why is an LP done at this time
Allows time for development of xanthochromia.
What is xanthochromia
a yellowing of the CSF from Hb breakdown.
How is xanthochromia detected
spectophotmetry of last (of 4) CSF bottles as there may be RBCs from first bottles due to traumatic tap
What vital sign has to be closely monitored
systolic BP should be aimed at < 180
What medication and what class of drug is it and why
nimodipine a calcium channel blocker to reduce Vasospasm
Possible neurosurgical interventions include
clipping and endovascular coil embolisation
3 possible neurological complications include
obstructive hydrocephalus, rebleeding and vasospssm in the circle of Willis
Other complications include
Pulmonary oedema and arrhythmia
